Surgical fastening elements and spinal column stabilization systems of the kind described at the outset are known, for example, from EP 2 266 483 A1. The known fastening elements, which, in particular, may be in the form of fastening screws, for example, pedicle screws, are inserted into adjacent vertebral bodies and connected to one another by one or more connecting elements, in order to stabilize the spinal column. The connecting elements may be rod-shaped and/or plate-shaped, so that a defined connection is in this way settable between adjacent vertebral bodies. The spinal column stabilization systems may, of course, also include further fastening elements and connecting elements, so that not only two, but also two, three or more movement segments of the spinal column can be coupled to one another and stabilized.
Introducing the connecting elements into the connecting element receptacle and then inserting the usually rather small fixing element is a problem, in particular, in minimally invasive implantation of such spinal column stabilization systems. For easier insertion of the fixing element, the connecting element is usually pressed into the connecting element receptacle.
In known systems, the introduction of the fastening elements and the fixing of the connecting elements consists, in principle, of several steps: introducing and anchoring the fastening element, inserting the connecting element into the connecting element receptacle, pressing the connecting element into the connecting element receptacle and then introducing the fixing element and fixing the connecting element immovably on the connecting element receptacle with the fixing element. The purpose of pressing the connecting element into the connecting element receptacle is, in particular, to bring the connecting element into a defined end position in the connecting element receptacle and hold it there so that the fixing element can be introduced and preferably fixed without force on the holding section, in order to fix the connecting element.
In particular, it is known to use external sleeves for pressing the connecting element into the connecting element receptacle. This does, however, have the disadvantage that a skin incision has to be significantly enlarged for this. Alternatively, fastening elements with elongated holding sections which, after the fixing element is fixed, may or must be partially removed, for example, by breaking off elongations on the holding section of the fixing element serving as guides, are also known. However, both variants have disadvantages which increase the effort involved in the surgery and, in particular, prolong the operating time.